Friday, November 23, 2012

Weekly Overseas Health IT Links - 24th November, 2012.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Health information exchanges are making progress in their quests to share electronic data among providers, with more data being exchanged and more HIEs becoming operational, according to the latest survey released by the eHealth Initiative.

Of the 161 HIE respondents, more than half, 88, are in the advanced stages of operational maturity, up from just 15 last year, reported Jason Goldwater, Vice President of Research and Programs for the eHealth Initiative, speaking on a webinar explaining the results of the survey.

WASHINGTON – Public health information exchanges (HIEs) have expressed concerns about compatibility and sustainability as the number of private HIEs continues to rise, according to eHealth Initiative's 12th Annual HIE Survey.

The survey of 161 HIEs nationwide indicates that if public and private HIEs are operating on different systems within a state or region, it will become increasingly difficult to exchange and leverage useful data to improve the quality and coordination of care in the United States, researchers said.

According to eHealth Initiative (eHI), there should be a level playing field between public and private HIEs.

Healthcare executives, physicians and consumers hold disparate views of the changes taking place in healthcare delivery and information technology, according to a new report from Greenway Medical Technologies.

The study involved focus groups with C-level healthcare executives and surveys of more than 1,000 physicians, CIOs, health IT professionals and consumers, according to an announcement.

Among the discrepancies: Physicians see themselves as those most responsible for creating a successful healthcare system, yet only 2 percent said they're actively taking steps to fix the current model. They're also unclear on who the other stakeholders should be. More than half of consumers, meanwhile, said government should take the lead on healthcare.

Epocrates has finally launched a native iPad version of it’s landmark drug information app, up until now a conspicuous and much-discussed omission. The release is part of a larger strategy by CEO Andy Hurd to turn around the struggling company, which posts its second annual loss this year on revenue estimates of about $110 million.

In an October 30 quarterly investor’s call, Hurd mentioned data from Manhattan that suggested Epocrates was the most downloaded iPad app by physicians, despite Epocrates not having a native iPad app. Doctors have been using the iPhone version of the app, viewing it at two times the size on their iPad screens.

The app, released for iPad and iPad mini, is essentially an adapted version of the existing Epocrates iPhone app, but Hurd told MobiHealthNews that the larger screen size allows for new kinds of functionality.

Mobile health is unsurprisingly even more popular among smartphone users, with 52 percent saying they have consulted their gadgets with medical questions.

The study, which is based on a national survey of more than 3,000 U.S. adults, also revealed that young adults and minorities are more likely to use their phones for health information. Caregivers and those who recently went through a medical crisis or significant change in their health status are other groups more likely to jump on the mobile health bandwagon.

By Rochelle Sharpe | New England Center for Investigative Reporting, Published: November 13

When the iTunes store began offering apps that used cellphone light to cure acne, federal investigators knew that hucksters had found a new spot in cyberspace.

“We realized this could be a medium for mischief,” said James Prunty, a Federal Trade Commission attorney who helped pursue the government’s only cases against health-app developers last year, shutting down two acne apps.

Since then, the Food and Drug Administration has been mired in a debate over how to oversee these high-tech products, and government officials have not pursued any other app developers for making medically dubious claims. Now, both the iTunes store and the Google Play store are riddled with health apps that experts say do not work and in some cases could even endanger people.

Hospital patients--even those with liver disease--often are given too much acetaminophen, which commonly is sold as Tylenol, but also is an ingredient in stronger narcotics such as Percocet and Vicodin, according to a study published in the Archives of Internal Medicine.

The researchers, from Partners HealthCare System in Wellesley, Mass., say better health IT systems are needed to monitor aggregate doses of ingredients such as acetaminophen when patients are given multiple medications, a Reuters story reports.

Implementing an electronic health record system provides a good return on investment for hospitals in low-income areas, according to a case study recently published in the Journal of the American Medical Information Association. The researchers studied the implementation of a hospital-wide EHR in a tertiary facility in Malawi, a nation in southeast Africa.

They noted that it was especially important to evaluate EHRs in low-income settings, because such hospitals suffer from additional problems, such as staff and supply shortages, which affect how fully the benefits of an EHR are realized They evaluated only three areas of impact: the length of stay, transcription times and lab use.

CARROLLTON, GA – A new survey released Thursday sheds light on health IT trends currently affecting the industry, with data showing that interoperability and costs are chief concerns for healthcare providers.

More than a quarter of respondents (26 percent) indicated that interoperability was a primary concern when it came to utilizing technology in their healthcare system, with overall costs closely following at 22 percent. Medical staff alignment and adapting to industry changes also were among the top concerns for providers.

Rep. Renee Ellmers (R-NC), chair of the House Committee on Small Business’ subcommittee on healthcare and technology, has sent a second letter to HHS Secretary Kathleen Sebelius asking for a study on the benefits, costs and safety of health information technology systems. Ellmers, a registered nurse with more than two decades of nursing and administrative experience in medical practices, says she received no reply from HHS for a letter sent this past summer. Following is text of the second letter to Sebelius, sent on Nov. 14:

“I am writing today to express my concern that the Department of Health and Human Services (Department) has failed to respond to my letter of June 12, 2012, requesting information on the Department’s actions following up on the Institute of Medicine’s November 8, 2011 report calling for greater oversight of health information technology (health IT). My office confirmed with the Department’s Office of Legislative Affairs that the letter was indeed received. I have included a copy of it for your review.

As health information exchanges spring up all over in response to regulations such as Meaningful Use and shifting payment models, the Indiana Health Information Exchange (IHIE) recommends healthcare leaders take a breath, top fixating on the technology and instead figure out what pays.

It happened. The campaign season we thought would never end did, and after billions of dollars spent on thousands of inescapable TV ads, we now have ... the same leaders we had before Election Day.

After all the speculation and prognostication, come January 2013, Barack Obama will still be President, John Boehner will still be speaker of the House and Harry Reid will still be Senate majority leader.

So what does this mean for health IT?

It means that doctors and hospitals can move forward with implementing electronic health records, as well as Obamacare, which included many health IT-related provisions. It means that more patients will have the ability to view, print or download their health records through online patient portals. It means that accountable care organizations sharing information electronically among providers will be better able to coordinate patient care. It means HHS will collect data on quality to measure where we can do better.

Bethesda, MD -- Redesigning primary care is an integral part of health reforms in the United States and elsewhere. A new study, being released today as a Web First by Health Affairs, surveyed primary care doctors in the United States and nine other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, and the United Kingdom.

The survey, conducted between March and July 2012, found US and German physicians the most negative about their health care systems: only 15 percent of US and 22 percent of German practitioners thought their systems worked well. On the brighter side, the survey found that 69 percent of US doctors report the use of electronic health records, bringing use in the United States closer to the Netherlands, New Zealand, the United Kingdom, and Norway, all with near-universal capacity.

A survey of primary care providers in 10 countries finds health IT can help improve care, but a large percent of physicians in all countries complained about the time it took to receive information from specialists and hospitals.

U.S. doctors were the most likely to report spending substantial time dealing with insurance restrictions and that their patients often went without care because of costs. As in previous surveys, U.S. physicians were more likely to be dissatisfied with the practice of medicine and to say U.S. healthcare needs to be overhauled.

The survey report by the non-profit Commonwealth Fund appears in Health Affairs.

BURLINGTON, VT – Optimizing patient flow throughout various healthcare settings continues to be a critical objective for hospitals, with nearly a third of industry officials planning to invest in patient flow solutions.

According to CapSite's "2012 U.S. Patient Flow Study" released Tuesday, some 31 percent of U.S. hospitals indicated their intentions to purchase patient flow solutions to address the current patient crowding bottleneck effect seen in hospital departments nationwide.

The study represents unique voice of customer insight from more than 420 hospitals on market adoption, market share, market opportunity and vendor mind share across the U.S. hospital market.

More and more, health IT is expanding from the clinical into the commercial realm. With patient engagement so crucial to the transformation of care delivery, that's a good thing. But some consumer technologies are better than others.

With "Designing Consumer Health IT: A Guide for Developers and Systems Designers," the agency seeks to help speed the development of "effective consumer health information technology applications so people can better use their personal health information to manage their health," officials say.

By NATASHA SINGER

“PLEASE put your hand on the scanner,” a receptionist at a doctor’s office at New York University Langone Medical Center said to me recently, pointing to a small plastic device on the counter between us. “I need to take a palm scan for your file.”

I balked.

As a reporter who has been covering the growing business of data collection, I know the potential drawbacks — like customer profiling — of giving out my personal details. But the idea of submitting to an infrared scan at a medical center that would take a copy of the unique vein patterns in my palm seemed fraught.

The receptionist said it was for my own good. The medical center, she said, had recently instituted a biometric patient identification system to protect against identity theft.

For more than two years Healthcare IT (HIT) has followed on a steady growth track, according to U.S. Bureau of Labor Statistics and that is likely to continue in the next few years, according to Bill Spooner, senior vice president and CIO at Sharp Healthcare. "HIT will continue to be a hot job market for the next two-three years," Spooner says.

The healthcare sector of IT walks a tightrope consisting of privacy, data security and the need to grow and update the infrastructure. HIT faces more challenges with HIPPA laws and privacy concerns then most other areas and with the convergence of mobile technologies, cloud computing, virtualization, clinical analytics and the upcoming IDC-10 (International Statistical Classification of Diseases and Related Health Problems), HIT could be the most active area within the IT sector next year. To help you hone in on where the career opportunities lie, here are eight HIT trends for 2013.

Scott Mace, for HealthLeaders Media , November 13, 2012

Lest anyone get the wrong idea, social media can do harm as well as good. Social media's power is awesome, but as the brilliant superhero Spiderman says, with great power comes great responsibility.

If you read my column last week, you know that clinicians and patients, speaking in their authentic voices, can trump formulaic marketing materials. But the need to employ a metric ton of common sense and discretion is greater than ever.

The challenge for health leaders is to instill that common sense and discretion into every employee, since social media is nonhierarchical by its nature, and tweets, blogs and Facebook posts don't work if they need to be preapproved (and they won't scale either).

After the National Institutes of Health grew interested in bioinformatics, following breakthroughts in the 1990s, the National Centers for Biomedical Computing were created with the goal of advancing the field by a few leaps and bounds, because IT systems hadn’t quite caught up to molecular biology.

The nine centers were founded through the 2000s, and with the advent of new data processing and visualization tools, there's been "an explosion of knowledge" in biomedical research, said Brian Athey, from the University of Michigan Medical School’s National Center for Integrative Bio Informatics (NCIBI).

Lack of guidance for physicians on disclosing conflicts of interest on social media sites such as Twitter is "an unacceptably gray area," Johns Hopkins postdoctoral fellow Matthew DeCamp writes in a commentary recently published in the Journal of General Internal Medicine.

"As physicians and patients increasingly interact online, the standards of appropriate behavior become really unclear," says DeCamp, a fellow in the School of Medicine's Division of General Internal Medicine. "In light of norms of disclosure accepted throughout medicine, it's surprising that major medical guidelines fail to adequately address this issue."

A study of the array of rule-authoring tools used to convert medical knowledge into machine-executable clinical decision support rules across Partners Healthcare in Boston found many limitations--and frustrations.

Most limit the ability to create CDS interventions that are standardized, sharable, interoperable and extensible, the authors found. None was deemed ideal.

The study, published at BMC Medical Informatics and Decision Making, reviewed through meetings with users of the clinical rule-authoring environments at Partners, who manage more than 7,000 CDS rules. It included an ad hoc collection of tools, some implemented enterprise-wide, some for ambulatory care only and others for specific systems. It focused on the process for creating and using reminder and medication rules.

With all the talk about switching from data centers to cloud-based computing, it seems like the cloud is an etherial magic bullet for every problem that healthcare IT might face, from reduced costs to improved flexibility. Not so fast, says Steve Jacobs, president of Velocity Data Centers, a firm that provides private cloud solutions.

While "there are some definite business advantages to operating in a cloud IT environment, the risks are very real and concerning," says Jacobs. For all of the pros of cloud-based solutions floating around, he points out that some of the cons can be big nails in the coffin for any organization that relies as much on data as healthcare does.

2013 will be a crucial year for physicians to avoid possible pay reductions under quality reporting and health information technology programs.

A physician’s decision not to report Medicare quality measures or participate in paperless prescribing and health record programs in 2013 will be a costly one in the long run.

The programs have been voluntary for the past several years. However, federal laws require Medicare rates eventually to be reduced for physicians who do not participate in the physician quality reporting system as well as the electronic health records and e-prescribing incentive programs. The reason why 2013 is such a critical year for doctors is that Medicare officials are using it as a benchmark for future penalties in all of these programs.

Health care provider organizations buying an information system go through a long process to select the right vendor, but oftentimes a single incident can make a difference in sealing the deal-or killing it.

For Kerry Noble, CEO at Pemiscot Memorial Health Systems in Hayti, Mo., his confidence in a particular electronic health records vendor went way up when Ramsey Evans, CEO of Prognosis Health Information Systems, wrote in the contract that he'd refund the cost of the software if the hospital did not attest to EHR meaningful use within 120 days of go-live. Noble then went to a local bank and got financing to cover the costs of implementation through attestation-with Prognosis' guarantee as collateral. The first meaningful use incentive payment exceeded the cost of the EHR by about $500,000, Noble says.

At 48-bed Sabine Medical Center in Many, La., the willingness of one vendor to make promises-and put them in writing-helped close the deal when the center purchased its first emergency department information system, says Karen Ford, R.N., chief nursing officer. Cost is-and always will be-a big part in the vendor selection process Ford says. But in this case, veEDIS Clinical Systems of Plantation, Fla., promised specific levels of 24x7 on-site, peer-to-peer support by nurses, physicians, and technicians for the first two weeks after go-live. "That is a big deal when you're trying to transition an emergency room," Ford says.

Facebook may become a tool in containing the next disease outbreak under a pilot program to mine social networks for real-time public health data.

Accenture Federal Services, Arlington, Va., a wholly owned subsidiary of Accenture LLP, was awarded a one-year, $3 million contract by the U.S. Homeland Security Department to help boost the biosurveillence capabilities of the Office of Health Affairs, according to a news release. The office is responsible for providing health and medical expertise to prepare for, respond to and recover from any hazard impacting the nation's health security, including biological threats.

A roughly $3 million "community supercomputer" being built in Tulsa offers an array of massive-number-crunching possibilities, including predictive modeling to improve the health of residents there.

Bruce Benjamin, associate dean for biomedical sciences at Oklahoma State University Center for Health Sciences said the supercomputer could identify patterns related to risk for heart disease from 15 measurements taken over eight hours from dozens of sleeping volunteers, according to a Tulsa World story.

Gerard Clancy, president of the University of Oklahoma-Tulsa, says the supercomputer could predict a person's conditions in 20 years--or could do so for the city as a whole, the World previously reported.

Physicians are more likely to want more conditions on the patient problem list in electronic health records even though that information might be duplicated elsewhere in the record, according to a study published at BMC Medical Informatics and Decision Making.

Problem lists are subjective, involve multiple providers and lack overall standards or policy as information is shared among healthcare organizations, the authors note.

"When problems are left out or hidden within a long and cluttered list, the problem lists' effectiveness is compromised. …To improve patient care and reap further benefit from the problem list as a data resource, the medical community needs to create clear, consistent, complete, and accurate problem lists. Unfortunately, the medical community's current approach to the problem list makes inconsistency and error the standard," they wrote.

To date, personal health record adoption has been somewhat limited, but the market is expected to get a big boost from Stage 2 of the meaningful use incentive program.

Deven McGraw -- director of the Health Privacy Project at the Center for Democracy & Technology -- said, "The market for those tools has been a little soft I think because people have really had to hand enter in the data or scan [them] in, as opposed to being able to feed [the information] directly from a provider's electronic health record, unless they happen to be a patient at Kaiser or part of a system that already offers them that tool." However, she said, "That's going to change in 2014 when a lot of the early adopters in the HITECH incentive program begin Stage 2 and start actively encouraging patients to view and potentially download and transmit their data."

But is the industry ready when it comes to privacy and security regulations?

Survey data show that consumers routinely cite privacy and security as top barriers to personal health record adoption. A 2010 survey from the California HealthCare Foundation found that 75% of U.S. adults without a PHR cited concerns about the privacy of their information as the top barrier to using a PHR. CHCF publishes iHealthBeat.